The FDA and the CDC, along with state and local health officials, have been investigating an outbreak of Shiga toxin-producing E. coli O157:H7 infections likely linked to leafy greens. There were 25 cases in 15 states; California (4), Connecticut (2), Illinois (1), Indiana (2), Maryland (3), Michigan (1), Nebraska (1), New Hampshire (2), New Jersey (1), New York (2), Ohio (1), Pennsylvania (2), Vermont (1), Virginia (1), and Washington (1).

Illness onsets were between November 5 and December 12, 2017. Among the 21ill people for whom CDC has information, nine were hospitalized, including one person in California who died. Two people developed hemolytic uremic syndrome, a type of kidney failure.

Since the outbreak was identified, the FDA has been working with CDC and state and local partners on the investigation. The FDA’s role in outbreaks of this nature is to utilize food consumption information gained from interviews with people who got sick, trace those foods back through the distribution chain to the original source, and attempt to identify the source and route of contamination.

In Canada, as of January 10, 2018, there were 42 cases of E. coli O157 illness reported in five eastern provinces: Ontario (8), Quebec (15), New Brunswick (5), Nova Scotia (1), and Newfoundland and Labrador (13). Individuals became sick in November and early December 2017. Seventeen individuals were hospitalized. One individual died. Individuals who became ill were between the ages of 3 and 85 years of age. The majority of cases (74%) were female. There is no evidence to suggest that provinces in western Canada were affected by this outbreak.

Most of the individuals who became sick reported eating romaine lettuce before their illnesses occurred. Individuals reported eating romaine lettuce at home, as well as in prepared salads purchased at grocery stores, restaurants and fast food chains. The Canadian Food Inspection Agency worked with public health officials to determine the source of the romaine lettuce that ill individuals were exposed to. As part of the food safety investigation into the source of contamination, the Canadian Food Inspection Agency tested romaine lettuce for the presence of E. coli. All food samples have tested negative and no source of contamination has been identified.

The FDA has been in regular contact with Canadian health authorities to share information about the traceback investigation. The FDA’s investigation team has also reviewed information from previous outbreaks to see if there are any commonalities between those and the current outbreak. To date, no common leafy green grower source has been identified.

Federal and state health officials are investigating a multistate Escherichia coli O157:H7 outbreak that has sickened 17 people in 13 states, and preliminary tests by the US Centers for Disease Control and Prevention (CDC) show that the outbreak strain is closely related to one in Canada that has been associated with romaine lettuce.

The CDC said illness onsets range from Nov 15 through Dec 8, according to a press release today sent to journalists. Affected states include California, Connecticut, Illinois, Indiana, Michigan, Nebraska, New Hampshire, New York, Ohio, Pennsylvania, Virginia, Vermont, and Washington.

State and local authorities are interviewing sick people to see what they ate in the week before they became ill. Because a source of the US infections hasn’t been identified, the CDC said it is unable to recommend if US residents should avoid a particular food. “This investigation is ongoing, and more information will be released as it becomes available,” it said.

The Public Health Agency of Canada (PHAC) issued its first announcement about an E coli outbreak linked to romaine lettuce on Dec 11. In a Dec 21 update, it said it is so far investigating 40 cases from five provinces: Ontario, Quebec, New Brunswick, Nova Scotia, and Newfoundland and Labrador. It urged the public to avoid eating romaine lettuce until more is known about the contamination.

One person is dead, two more provinces are reporting illnesses and nine more people are confirmed sick, but no one has recalled any products, named any brands, or identified any retailers who sold fresh romaine lettuce that is implicated in an E. coli outbreak in Canada.

The Public Health Agency of Canada reported the death and additional victims late Thursday. The agency first acknowledged the E. coli O157:H7 outbreak Monday, reporting 21 people confirmed sick across three provinces, Quebec, New Brunswick and Labrador and Newfoundland.

Canadian health officials added Ontario and Nova Scotia to the outbreak map Thursday when they increased the confirmed victim count to 30. The outbreak update did not indicate what province had recorded the death.

The most recent person became sick on Dec. 2, suggesting the implicated romaine lettuce could still be in the stream of commerce. Canadian officials have not reported whether the romaine lettuce identified by victims was whole head, leaves, hearts or chopped.

“Many individuals who became sick reported eating romaine lettuce before their illnesses occurred,” according to the outbreak from the federal health agency. “The Canadian Food Inspection Agency (CFIA) is working with public health officials to determine the source of the romaine lettuce that ill individuals were exposed to.

“At this time, there are no product recalls associated with this outbreak. The outbreak investigation is ongoing, and this public health notice will be updated on a regular basis as the investigation evolves.”

It is likely additional victims will be identified because it can take up to 10 days after exposure for symptoms to develop. Then, it can take several weeks from the time a person becomes ill to when the illness is reported and testing confirms a link to the outbreak, according to the public health agency.

Of the 19 people for whom specific information is available, illness onset dates range from Nov. 16 through Dec. 2. A dozen of the victims have had symptoms so severs that they required hospitalization. The age range of the victims is 4 to 80 years old.

The public health agency notice does not indicate when federal officials became aware of the outbreak or why it was not revealed to the public until Dec. 11.

Approximately 214 recruits at both MCRD San Diego and the command’s field training facilities at Edson Range, Camp Pendleton, Calif., are symptomatic of E.Coli exposure with diarrheal illness as of Nov. 1. Of the 214 recruits undergoing treatment, 26 are new cases among the more than 5500 recruits in training. Twelve recruits are admitted to an off-base medical facility while the remainder are being cared for aboard the base.

“The command’s full effort is focused on caring for those recruits who are affected, ensuring we limit any spread of the illness, and identifying the source of the infection,” said Brig. Gen. William Jurney, commanding general, MCRD San Diego and the Western Recruiting Region.

The below updated actions highlight current efforts in addition to what has been previously released:

– Samples and specimens have been forwarded for testing to the US Army Public Health Command located aboard Fort Sam Houston, San Antonio, TX, where they will be tested and processed by the Food Analysis and Diagnostic Lab to determine the cause of the illness.

Family members will be contacted by the command if a recruit is hospitalized or his graduation date changes due to missed training resulting from sickness. Every effort will be made to allow recruits to complete missed training with their original training unit in order to remain on track for their planned graduation date.

Troy Neumann of WKBT reports several recent cases of E. coli are concerning some residents of the La Crosse area.

The La Crosse County Health Department is currently investigating eight reported cases of E. coli in the county. The strain found in our area is known to cause diarrhea, potentially hospitalizing young children.

The Health Department says good hygiene is one of the best and easiest things you can do to prevent an E. coli infection.

“Good hand washing after using the bathroom, good hand washing after changing diapers, good hand washing before preparing food, and good hand washing after coming in from outside are all those hand hygiene things that we would recommend that people do,” said La Crosse County Health Department Health Education Manager Paula Silha.

The La Crosse County Health Department is still investigating eight reports of E. coli in the La Crosse area.

Escherichia coli (E. coli) is an archetypal commensal bacterial species that lives in mammalian intestines. E. coli O157:H7 is one of thousands of serotypes E. coli.[1] The combination of letters and numbers in the name of E. coli O157:H7 refers to the specific antigens (proteins which provoke an antibody response) found on the body, as well as on the tail, or flagellum,[2] and distinguish it from other types of E. coli.[3] Most serotypes of E. coli are harmless and live as normal flora in the intestines of healthy humans and animals.[4]

The E. coli bacterium is among the most extensively studied microorganisms.[5] The testing to distinguish E. coli O157:H7 from its other E. coli counterparts is called serotyping.[6] Pulsed-field gel electrophoresis (PFGE),[7] sometimes also referred to as genetic fingerprinting, is used to compare E. coli O157:H7 isolates to one another to determine if the strains are distinguishable.[8] A technique called multilocus variable number of tandem repeats analysis (MLVA) is used to determine precise classification when it is difficult to differentiate between isolates with indistinguishable or very similar PFGE patterns.[9]

The E. coli O157:H7 Bacteria

E. coli O157:H7 was first recognized as a pathogen in 1982 during an investigation into an outbreak of hemorrhagic colitis[10] associated with consumption of hamburgers from a fast food chain restaurant.[11] Retrospective examination of more than three thousand E. coli cultures obtained between 1973 and 1982 found only one (1) isolation with serotype O157:H7, and that was a case in 1975.[12] In the ten (10) years that followed there were approximately thirty (30) outbreaks recorded in the United States.[13] This number is likely misleading, however, because E. coli O157:H7 infections did not become a reportable disease in any state until 1987, when Washington became the first state to mandate its reporting to public health authorities.[14] As a result, only the most geographically concentrated outbreak would have garnered enough notice to prompt further investigation.[15]

E. coli O157:H7’s ability to induce injury in humans is a result of its ability to produce numerous virulence factors—most notably, Shiga-like toxins (SLT).[16] Shiga toxin (Stx) has multiple variants (e.g. Stx1, Stx2, Stx2c), and acts like the plant toxin ricin by inhibiting protein synthesis in endothelial and other cells.[17] Shiga toxin is one of the most potent toxins known.[18] In addition to Shiga toxins, E. coli O157:H7 produces numerous other putative virulence factors including proteins, which aid in the attachment and colonization of the bacteria in the intestinal wall and that can lyse red blood cells to liberate iron that helps support E. coli metabolism.[19]

E. coli O157:H7 evolved from enteropathogenic E. coli serotype O55:H7, a cause of non-bloody diarrhea, through the sequential acquisition of phage-encoded Stx2, a large virulence plasmid, and additional chromosomal mutations.[20] The rate of genetic mutation of E. coli O157:H7 indicates that the common ancestor of current E. coli O157:H7 clades[21] likely existed some 20,000 years ago.[22]E. coli O157:H7 is a relentlessly evolving organism[23], constantly mutating and acquiring new characteristics, including virulence factors that make the emergence of more dangerous variants a constant threat.[24] The CDC has emphasized the prospect of emerging pathogens as a significant public health threat for some time.[25]

Although foods of a bovine origin are the most common cause of both outbreaks and sporadic cases of E. coli O157:H7 infections,[26] outbreak of illnesses have been linked to a wide variety of food items. For example, produce has, since 1991, been the source of substantial numbers of outbreak-related E. coli O157:H7 infections.[27] Other unusual vehicles for E. coli O157:H7 outbreaks have included unpasteurized juices, yogurt, dried salami, mayonnaise, raw milk, game meats, sprouts, and raw cookie dough.[28]

According to a recent study, an estimated 93,094 illnesses are caused by domestically acquired E. coli O157:H7 each year in the United States.[29] It is estimated that foodborne acquired O157:H7 cases result in 2,138 hospitalizations and 20 deaths annually.[30]

The colitis caused by E. coli O157:H7 is characterized by severe abdominal cramps, diarrhea that typically turns bloody within twenty-four hours, and sometimes fevers.[31] The incubation period—which is to say the time from exposure to the onset of symptoms—in outbreaks is usually reported as three to four days, but may be as short as one day or as long as ten days.[32] Infection can occur in people of all ages but is most common in children.[33] The duration of an uncomplicated illness can range from one to twelve days.[34] Although the rate of death is 0-2 percent in reported outbreaks, in outbreaks that involve the elderly, like those that have occurred in nursing homes, the rate of death can run as high as 16-35%.[35]

What makes E. coli O157:H7 remarkably dangerous is its very low infectious dose,[36] and how relatively difficult it is to kill the bacteria.[37] Unlike Salmonella, for example, which usually requires something approximating an “egregious food handling error, E. coli O157:H7 in ground beef that is only slightly undercooked can result in infection,”[38] as few as twenty organisms may be sufficient to infect a person and, as a result, possibly kill them.[39] And unlike generic E. coli, the O157:H7 serotype multiplies at temperatures up to 44°F, survives freezing and thawing, is heat resistant, grows at temperatures up to 111°F, resists drying, and can survive exposure to acidic environments.[40]

And, finally, to make it even more of a threat, E. coli O157:H7 bacteria are easily transmitted by person-to-person contact.[41] There is also the serious risk of cross-contamination between raw meat and other food items intended to be eaten without cooking. Indeed, a principle and consistent criticism of the USDA E. coli O157:H7 policy is the fact that it has failed to focus on the risks of cross-contamination versus that posed by so-called improper cooking.[42] With this pathogen, there is ultimately no margin of error. It is for this precise reason that the USDA has repeatedly rejected calls from the meat industry to hold consumers primarily responsible for E. coli O157:H7 infections caused, in part, by mistakes in food handling or cooking.[43]

Hemolytic Uremic Syndrome (HUS)

E. coli O157:H7 infections can lead to a severe, life-threatening complication called hemolytic uremic syndrome (“HUS”).[44] HUS accounts for the majority of the acute and chronic illness and death caused by E coli bacteria.[45] HUS occurs in 2-7% of victims who are primarily children, with onset occurring five to ten days after diarrhea begins.[46] HUS is the most common cause of renal failure in children.[47] Approximately half of the children who suffer HUS require dialysis, and at least 5% of those who survive have long-term renal impairment.[48] The same number suffers severe brain damage.[49] While somewhat rare, serious injury to the pancreas, resulting in death or the development of diabetes, can also occur.[50] There is no cure or effective treatment for HUS.[51] And, tragically, as too many parents can attest, children with HUS too often die.[52]

HUS is believed to develop when SLT from the bacteria enters circulation in the body through the inflamed bowel wall.[53] SLT, and most likely other chemical mediators, attach to receptors on the inside surface of blood vessel cells (endothelial cells) and initiate a chemical cascade that results in the formation of tiny thrombi (blood clots) within these vessels.[54] Some organs seem more susceptible, perhaps due to the presence of increased numbers of receptors, and include the kidney, pancreas, and brain.[55] By definition, when fully expressed, HUS presents with the triad of hemolytic anemia (destruction of red blood cells), thrombocytopenia (low platelet count), and renal failure (loss of kidney function).[56]

As already noted, there is no known therapy to halt the progression of HUS. HUS is a frightening complication that even in the best American medical centers has a notable mortality rate.[57] Among survivors, at least five percent will suffer end stage renal disease (ESRD) with the resultant need for dialysis or transplantation.[58] But “[b]ecause renal failure can progress slowly over decades, the eventual incidence of ESRD cannot yet be determined.”[59] Other long-term problems include the risk for hypertension, proteinuria (abnormal amounts of protein in the urine that can portend a decline in renal function), and reduced kidney filtration rate.[60] Since the longest available follow-up studies of HUS victims are twenty-five years, an accurate lifetime prognosis is not really available and remains controversial.[61] All that can be said for certain is that HUS causes permanent injury, including loss of kidney function, and it requires a lifetime of close medical monitoring.

Irritable Bowel Syndrome

A recently-published study surveyed the extant scientific literature and noted that post-infectious irritable bowel syndrome (PI-IBS) is a common clinical phenomenon first-described over five decades ago.[62] The Walkerton Health Study further notes that:

Between 5% and 30% of patients who suffer an acute episode of infectious gastroenteritis develop chronic gastrointestinal symptoms despite clearance of the inciting pathogens.[63]

In terms of its own data, the “study confirm[ed] a strong and significant relationship between acute enteric infection and subsequent IBS symptoms.”[64] The WHS also identified risk-factors for subsequent IBS, including: younger age; female sex; and four features of the acute enteric illness—diarrhea for > 7days, presence of blood in stools, abdominal cramps, and weight loss of at least ten pounds.[65]

Irritable bowel syndrome (IBS) is a chronic disorder characterized by alternating bouts of constipation and diarrhea, both of which are generally accompanied by abdominal cramping and pain.[66] In one recent study, over one-third of IBS sufferers had had IBS for more than ten years, with their symptoms remaining fairly constant over time.[67] IBS sufferers typically experienced symptoms for an average of 8.1 days per month.[68]

As would be expected from a chronic disorder with symptoms of such persistence, IBS sufferers required more time off work, spent more days in bed, and more often cut down on usual activities, when compared with non-IBS sufferers.[69] And even when able to work, a significant majority (67%), felt less productive at work because of their symptoms.[70] IBS symptoms also have a significantly deleterious impact on social well-being and daily social activities, such as undertaking a long drive, going to a restaurant, or taking a vacation.[71] Finally, although a patient’s psychological state may influence the way in which he or she copes with illness and responds to treatment, there is no evidence that supports the theory that psychological disturbances in fact cause IBS or its symptoms.[72]

[1]E. coli bacteria were discovered in the human colon in 1885 by German bacteriologist Theodor Escherich. Feng, Peter, Stephen D. Weagant, Michael A. Grant, Enumeration of Escherichia coli and the Coliform Bacteria, in BACTERIOLOGICAL ANALYTICAL MANUAL (8th Ed. 2002), http://www.cfsan.fda.gov/~ebam/bam-4.html. Dr. Escherich also showed that certain strains of the bacteria were responsible for infant diarrhea and gastroenteritis, an important public health discovery. Id. Although the bacteria were initially called Bacterium coli, the name was later changed to Escherichia coli to honor its discoverer. Id.

[2] Not all E. coli are motile. For example, E. coli O157:H7 which lack flagella are thus E. coli O157:NM for non-motile.

[8]Id. Through PFGE testing, isolates obtained from the stool cultures of probable outbreak cases can be compared to the genetic fingerprint of the outbreak strain, confirming that the person was in fact part of the outbreak. Bell, supra note 6, at 1351-52. Because PFGE testing soon proved to be such a powerful outbreak investigation tool, PulseNet, a national database of PFGE test results was created. Bala Swaminathan, et al. PulseNet: The Molecular Subtyping Network for Foodborne Bacterial Disease Surveillance, United States, 7 Emerging Infect. Dis. (No. 3) 382, 382-89 (May-June 2001) (recounting the history of PulseNet and its effectiveness in outbreak investigation).

[10] “[A] type of gastroenteritis in which certain strains of the bacterium Escherichia coli (E. coli) infect the large intestine and produce a toxin that causes bloody diarrhea and other serious complications.” The Merck Manual of Medical Information, 2nd Home Ed. Online, http://www.merck.com/mmhe/sec09/ch122/ch122b.html.

[15]See Keene, supra note 14 at 583. (“With cases scattered over four counties, the outbreak would probably have gone unnoticed had the cases not been routinely reported to public health agencies and investigated by them.”) With improved surveillance, mandatory reporting in 48 states, and the broad recognition by public health officials that E. coli O157:H7 was an important and threatening pathogen, there were a total of 350 reported outbreaks from 1982-2002. Josef M. Rangel, et al. Epidemiology of Escherichia coli O157:H7 Outbreaks, United States, 1982-2002, 11 Emerging Infect. Dis. (No. 4) 603, 604 (April 2005).

[16] Griffin & Tauxe supra note 12, at 61-62 (noting that the nomenclature came about because of the resemblance to toxins produced by Shigella dysenteries).

[17] Sanding K, Pathways followed by ricin and Shiga toxin into cells, Histochemistry and Cell Biology, vol. 117, no. 2:131-141 (2002). Endothelial cells line the interior surface of blood vessels. They are known to be extremely sensitive to E. coli O157:H7, which is cytotoxigenic to these cells making them a primary target during STEC infections.

[24] Manning SD, et al. Variation in virulence among clades of Escherichia coli O157:H7 associated with disease outbreaks. PNAS vol. 105 no. 12 4868-4873 (2008). (“These results support the hypothesis that the clade 8 lineage has recently acquired novel factors that contribute to enhanced virulence. Evolutionary changes in the clade 8 subpopulation could explain its emergence in several recent foodborne outbreaks; however, it is not clear why this virulent subpopulation is increasing in prevalence.”)

[25] Robert A. Tauxe, Emerging Foodborne Diseases: An Evolving Public Health Challenge, 3 Emerging Infect. Dis. (No. 4) 425, 427 (Oct.-Dec. 1997). (“After 15 years of research, we know a great deal about infections with E. coli O157:H7, but we still do not know how best to treat the infection, nor how the cattle (the principal source of infection for humans) themselves become infected.”)

[36] Griffin & Tauxe supra note 12, at 72. (“The general patterns of transmission in these outbreaks suggest that the infectious dose is low.”)

[37] V.K. Juneja, O.P. Snyder, A.C. Williams, and B.S. Marmer, Thermal Destruction of Escherichia coli O157:H7 in Hamburger, 60 J. Food Prot. (vol. 10). 1163-1166 (1997) (demonstrating that, if hamburger does not get to 130°F, there is no bacterial destruction, and at 140°F, there is only a 2-log reduction of E. coli present).

[38] Griffin & Tauxe supra note 12, at 72 (noting that, as a result, “fewer bacteria are needed to cause illness that for outbreaks of salmonellosis”). Nestle, supra note 4, at 41. (“Foods containing E. coli O17:H7 must be at temperatures high enough to kill all of them.”) (italics in original)

[39] Patricia M. Griffin, et al. Large Outbreak of Escherichia coli O157:H7 Infections in the Western United States: The Big Picture, in RECENT ADVANCES IN VEROCYTOTOXIN-PRODUCING ESCHERICHIA COLI INFECTIONS, at 7 (M.A. Karmali & A. G. Goglio eds. 1994). (“The most probable number of E. coli O157:H7 was less than 20 organisms per gram.”) There is some inconsistency with regard to the reported infectious dose. Compare Chryssa V. Deliganis, Death by Apple Juice: The Problem of Foodborne Illness, the Regulatory Response, and Further Suggestions for Reform, 53 Food Drug L.J. 681, 683 (1998) (“as few as ten”) with Nestle, supra note 4, at 41 (“less than 50”). Regardless of these inconsistencies, everyone agrees that the infectious dose is, as Dr. Nestle has put it, “a miniscule number in bacterial terms.” Id.

[41] Griffin & Tauxe supra note 12, at 72. The apparent “ease of person-to-person transmission…is reminiscent of Shigella, an organism that can be transmitted by exposure to extremely few organisms.” Id. As a result, outbreaks in places like daycare centers have proven relatively common. Rangel, supra note 15, at 605-06 (finding that 80% of the 50 reported person-to-person outbreak from 1982-2002 occurred in daycare centers).

[42]See, e.g. National Academy of Science, Escherichia coli O157:H7 in Ground Beef: Review of a Draft Risk Assessment, Executive Summary, at 7 (noting that the lack of data concerning the impact of cross-contamination of E. coli O157:H7 during food preparation was a flaw in the Agency’s risk-assessment), http://www.nap.edu/books/0309086272/html/.

[43]Kriefall v. Excel, 265 Wis.2d 476, 506, 665 N.W.2d 417, 433 (2003). (“Given the realities of what it saw as consumers’ food-handling patterns, the [USDA] bored in on the only effective way to reduce or eliminate food-borne illness”—i.e., making sure that “the pathogen had not been present on the raw product in the first place.”) (Citing Pathogen Reduction, 61 Fed. Reg. at 38966).

[45] Siegler, supra note 35 at 1505. (“[HUS] is now recognized as the most frequent cause of acute renal failure in infants and young children.”) See also Beth P. Bell, MD, MPH, et al., Predictors of Hemolytic Uremic Syndrome in Children During a Large Outbreak of Escherichia coli O157:H7 Infections, 100 Pediatrics 1, 1 (July 1, 1997), at http://www.pediatrics.org/cgi/content/full/100/1/e12.

[51] Safdar, supra note 37, at 996; see also Siegler, supra note 35, at 1379. (“There are no treatments of proven value, and care during the acute phase of the illness, which is merely supportive, has not changed substantially during the past 30 years.”)

[52] Su & Brandt, supra note 9 (“the mortality rate is 5-10%”). See also Kriefall, 265 N.W.2d at 483 (“three-year old Brianna Kriefall died from food that everyone party to this appeal…recognize was cross-contaminated by E. coli O157:H7 bacteria from meat sold by Excel.”)

[57] Siegler, supra note, at 1519 (noting that in a “20-year Utah-based population study, 5% dies, and an equal number of survivors were left with end-stage renal disease (ESRD) or chronic brain damage.”)

[62] J. Marshall, et al., Incidence and Epidemiology of Irritable Bowel Syndrome After a Large Waterborne Outbreak of Bacterial Dysentery, Gastro., 2006; 131;445-50 (hereinafter “Walkerton Health Study” or “WHS”). The WHS followed one of the largest E. coli O157:H7 outbreaks in the history of North America. Contaminated drinking water caused over 2,300 people to be infected with E. coli O157:H7, resulting in 27 recognized cases of HUS, and 7 deaths. Id. at 445. The WHS followed 2,069 eligible study participants. Id. For Salmonella specific references, see Smith, J.L., Bayles, D.O., Post-Infectious Irritable Bowel Syndrome: A Long Term Consequence of Bacterial Gastroenteritis, Journal of Food Protection. 2007:70(7);1762-1769.

[72] Amy Foxx-Orenstein, DO, FACG, FACP, IBS—Review and What’s New, General Medicine 2006:8(3) (Medscape 2006) (collecting and citing studies). Indeed, PI-IBS has been found to be characterized by more diarrhea but less psychiatric illness with regard to its pathogenesis. See Nicholas J. Talley, MD, PhD, Irritable Bowel Syndrome: From Epidemiology to Treatment, from American College of Gastroenterology 68th Annual Scientific Meeting and Postgraduate Course (Medscape 2003).

According to Food Safety News, the E. coli outbreak in southwest Utah that has already killed two is growing, and public health officials there have warned people to avoid consuming raw milk or recently purchased ground beef.

Officials with the Southwest Utah Public Health Department initially reported six victims in a July 3 health alert. As of Tuesday, 11 victims had been confirmed. The first victim was a 3-year-old boy who died in June. He and the other fatality, a 6-year-old girl, were not related but they lived in the same apartment building in Hildale.

The source of the outbreak in Hildale, UT, remains under investigation, according to health department spokesman David Heaton who is quoted in local media reports.

Heaton told the Salt Lake Tribune newspaper on Tuesday that the public alert about raw milk and “recently purchased ground beef” is a standard warning and that there is not a confirmed link to such products. He also told the newspaper there could be multiple sources for the E. coli, or the original patient could have contaminated food or surfaces, resulting in additional people becoming infected.

The Canadian Food Inspection Agency (CFIA) has added more brands to its recall list of flour and flour based products, over further fears of E. coli contamination.

“It is not safe to taste or eat raw dough or batter regardless of the type of flour used, as raw flour can be contaminated with harmful bacteria such as E. coli O121,” wrote the CFIA in a news release.

The latest recall includes durum atta flour, a flour used to make South Asian flatbreads, and sooji flour, which is used in Indian and Pakistani desserts.

Also added to the list are bread flours, including whole wheat and multigrain bread flours.

Although the bacteria may not cause contaminated food to look or smell spoiled, the CFIA says it can still make you sick.

Marcho Farms, Inc., a Souderton, Pa. establishment, is recalling approximately 5,620 pounds of boneless veal, and ground veal, beef and pork products that may be adulterated withnon-O157 Shiga toxin-producing E. coli (STEC) O111, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today.

The veal, beef and pork products were produced on April 11 and April 14, 2017. The following products are subject to recall: [View Labels (PDF Only)]

These items were distributed to retail stores and food service locations in Illinois, New York, North Carolina, Pennsylvania, South Carolina and Virginia.

The problem was discovered when the Illinois State Meat Inspection Service notified FSIS on May 2, 2017, about positive non-O157 Shiga toxin-producing E. coli (STEC) samples made with source material produced by Marcho Farms, Inc. There have been no confirmed reports of adverse reactions due to consumption of these products.

Non-O157 Shiga toxin-producing E. coli (STEC) outbreaks are rare, but tend to primarily be due to contaminated food and person-to-person transmission. Like E. coli O157:H7, non-O157 Shiga toxin-producing E. coli (STEC) is a potentially deadly bacterium that can cause dehydration, bloody diarrhea and abdominal cramps 2–8 days (3–4 days, on average) after exposure the organism. While most people recover within a week, some develop a type of kidney failure called hemolytic uremic syndrome (HUS). This condition can occur among persons of any age but is most common in children under 5-years old and older adults. It is marked by easy bruising, pallor, and decreased urine output. Persons who experience these symptoms should seek emergency medical care immediately.

FSIS and the company are concerned that some product may be frozen and in consumers’ freezers.

Consumers who have purchased these products are urged not to consume them.

Stay Connected

About this blog

The E. coli blog supplements Marler Clark’s Web site About E. coli, a site that provides information about E. coli O157:H7, the symptoms and risks of infection, E. coli testing/detection, and how to prevent E. coli outbreaks.